Академический Документы
Профессиональный Документы
Культура Документы
03/05
Medical Benefits:
Questions and Answers
About the
Energy Employees
Occupational Illness
Compensation Program
Contents…
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
19. Should I keep copies of the bills that I send to the EEOICP? . .21
Samples…
Sample Page
INTRO IN
Introduction
INTRO
As a qualified claimant under the U.S. Department of
Labor’s Energy Employees Occupational Illness
Compensation Program (EEOICP), you are entitled to INTRO
medical benefits to cover the reasonable cost of
treatment for your covered condition(s). Medical
providers (such as physicians, pharmacies, and
INTRO
hospitals) may bill the Department of Labor medical
bill processing facility directly.
●
Medical benefits – covered and non-covered INTRO
services; and
●
Reimbursement for medical care and associated INTRO
travel.
INTRO
INTRO
INTRO
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INTRO
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Doctor’s office visits, medical treatments,
INTRO hospital visits, and consultations;
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Inpatient and outpatient hospital charges,
INTRO including emergency room visits for the
accepted conditions, diagnostic laboratory
testing, and chest x-rays;
INTRO ●
Drugs prescribed by a doctor, both brand
name and generic;
INTRO ●
Ambulance services; and
●
Travel to the doctor, hospital, clinic, other
INTRO medical facility, or pharmacy.
●
Overnight travel, related meals and lodging,
INTRO and/or mileage that exceeds 200 miles
round trip;
INTRO
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INTRO
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Treatment for consequential conditions; Q:
1, 2
●
Special equipment as prescribed or
recommended by the treating physician
especially those items over $5,000. INTRO
INTRO
INTRO
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INTRO
●
Treatment of medical problems not related
to your covered condition(s); INTRO
●
Medical treatment for your spouse or other Q:
family members; 3, 4,
5, 6
●
Medicine that is not prescribed by a doctor;
and INTRO
●
Personal services in the hospital, such as
TV or telephone.
INTRO
5. Question: What is the best way to get my medical
bills paid?
INTRO
Answer: Whenever possible, have your doctor,
hospital, pharmacy, and other medical providers
bill the Department of Labor directly. If providers INTRO
are enrolled in the EEOICP, the Department of
Labor will pay them directly.
INTRO
Your provider may also obtain enrollment
information at the following website:
http://owcp.dol.acs-inc.com.
INTRO
6. Question: How can a medical provider get
enrollment and billing information from
the EEOICP? INTRO
INTRO
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INTRO
INTRO
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INTRO
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INTRO
To obtain reimbursement, complete the U.S.
Department of Labor Claim for Medical
INTRO Reimbursement Form, OWCP-915, as shown in
Sample 1 on page 9. In addition to the OWCP-
915, you must submit the provider's billing
INTRO statement, receipt of payment by your provider
and evidence of your method of payment.
Acceptable evidence of payment include: a cash
INTRO receipt, a copy of your canceled check (both
front and back) or a copy of your credit card
receipt.
Q: 11
S: 1 Up to eight visits or services can be listed on this
form. However, each line used must be filled in
completely. Statements such as “see attached” or
INTRO “see attached receipts” are not acceptable when
used in any of the boxes on the form.
All medical bills submitted to the EEOICP are
INTRO subject to a fee schedule.
INTRO
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
Q: 11
S: 1
INTRO
INTRO
INTRO
Sample 1 – Claim for Medical Reimbursement
(Doctor Visit)
INTRO
INTRO
INTRO
INTRO
INTRO
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INTRO
INTRO
●
Your full name, address, and Social Security
number; INTRO
●
Name of the prescribing doctor;
INTRO
●
Name and address of the pharmacy;
●
Prescription number; INTRO
●
Amount prescribed – mg/ml or cc and total or
cc per bottle for liquid medication, and/or mg
INTRO
per tablet and total number of tablets per
prescription;
Q: 12
●
Date purchased;
●
Name of each drug;
INTRO
●
11-digit National Drug Code (NDC) number for
the prescribed medication;
INTRO
●
Charge actually paid for each drug less any
discount (for example, senior citizen, coupon);
and INTRO
●
A statement marked “patient paid” or “paid by
patient” showing specifically who paid the
charges. “Paid” or “paid in full” are not INTRO
acceptable.
INTRO
INTRO
Q: 12
S: 2
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
Q: 12
S: 2
INTRO
INTRO
INTRO
Sample 2 – Claim for Medical Reimbursement
(Prescription Drugs)
INTRO
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
S: 3, 4
INTRO
INTRO
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
S: 3, 4
INTRO
INTRO
INTRO
INTRO
INTRO
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INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
Q: 13, 14
S: 5
INTRO
Sample 5 – Medical Travel Refund Request
INTRO
INTRO ●
The date of service;
●
The amount of your reimbursement request;
INTRO
●
The amount you will be paid;
INTRO ●
A RV number on the top left-hand side of the
form (this number will also appear on your
check, if you receive a payment, so you can
INTRO match payments with your reimbursement
requests); and
●
Explanation of Benefits Codes (EOB Codes)
INTRO will explain why you were not paid for any
portion of the reimbursement request.
Q: 15, 16
S: 6 You will not receive a Remittance Voucher if your
medical provider bills the Department of Labor
directly.
INTRO
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
INTRO
Q: 15, 16
S: 6
Sample 6 – Remittance Voucher (Front of Form)
INTRO
INTRO
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INTRO
INTRO
INTRO
INTRO
Q: 20,
21
District
Offices
INTRO
22
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INTRO
INTRO
Q: 20,
21
District
Offices
INTRO
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INTRO
INTRO
INTRO
INTRO
INTRO
District
Offices
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